ADHD Children Need To Be Tested For Heart Before Treatment

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Apr 22 2008 - 8:03am

The stimulant drugs, used for ADHD treatment, while not much significant, are important to monitor for children with ADHD and certain heart conditions. This is why ADHD children should receive an electrocardiogram (ECG) to rule out heart abnormalities before beginning ADHD treatment with stimulant drugs.

American Heart Association says that children currently taking stimulant drugs for ADHD Treatment who did not have an ECG prior to treatment should get an ECG.

Children with attention deficit hyperactivity disorder (ADHD) should get careful cardiac evaluation and monitoring - including an electrocardiogram (ECG) - before starting treatment with stimulant drugs, a new American Heart Association statement recommends.

View the Scientific Statement here

The scientific statement on Cardiovascular Monitoring of Children and Adolescents with Heart Disease Receiving Stimulant Drugs is published online in Circulation: Journal of the American Heart Association.

In 1999, concerns over potential cardiovascular effects of psychotropic drugs, especially tricyclic antidepressants, but including stimulants, prompted an American Heart Association Scientific Statement: Cardiovascular Monitoring of Children and Adolescents Receiving Psychotropic Drugs. However, no specific cardiovascular monitoring was recommended for the use of stimulant medications. Warnings from the U. S. Food and Drug Administration (FDA) about stimulant medications and public concern for the safety of using them have prompted the current statement.

Studies have shown that stimulant medications like those used to treat ADHD can increase heart rate and blood pressure. These side effects are insignificant for most children with ADHD; however, they're an important consideration for children who have a heart condition. Certain heart conditions increase the risk for sudden cardiac death (SCD), which occurs when the heart rhythm becomes erratic and doesn't pump blood through the body.

Doctors usually use a physical exam and the patient and family history to detect the risk for or presence of health problems before beginning new treatments, including prescribing medication. But some of the cardiac conditions associated with SCD may not be noticed in a routine physical exam. Many of these conditions are subtle and do not result in symptoms or have symptoms that are vague such as palpitations, fainting or chest pain.

That's why the statement writing group recommends adding an ECG to pre-treatment evaluations for children with ADHD. An ECG measures the heart's electrical activity and can often identify heart rhythm abnormalities such as those that can lead to sudden cardiac death.

"After ADHD is diagnosed, but before therapy with a stimulant or other medication is begun, we suggest that an ECG be added to the pre-treatment evaluation to increase the likelihood of identifying cardiac conditions that may place the child at risk for sudden death," said Victoria L. Vetter, M.D., head of the statement writing committee and Professor of Pediatrics at the University of Pennsylvania School of Medicine in Philadelphia.

Vetter also said doctors should evaluate children and adolescents already taking these medications if they were not evaluated when they started the treatment.

If heart problems are suspected after the evaluation, children should be referred to a pediatric cardiologist. Once stimulant treatment begins, children should have their heart health monitored periodically, with a blood pressure check within one to three months, then again at routine follow-ups every six to 12 months.

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"Children can have undiagnosed heart conditions without showing symptoms," Vetter said. "Furthermore, a child's body changes constantly, with some conditions not appearing until adolescence."

If the initial ECG was taken before age 12 years, it may be useful to do a repeat ECG after the child is over age 12 years, the statement says.

Widespread use of ECGs to detect heart abnormalities, including screenings for competitive athletes, is not routinely recommended by the American Heart Association. However, the writing group found using ECG screening in this specific population of children prescribed ADHD medication is medically indicated and reasonably priced. That said, however, lack of an ECG shouldn't mean that kids who need ADHD treatment can't get it.

"While we feel that an ECG is reasonable and helpful as a tool to identify children with cardiac conditions that can lead to SCD, if, in the view of their physician, a child requires immediate treatment with stimulant medications, this recommendation is not meant to keep them from getting that treatment," said Vetter, who added that some children may not have access to a pediatric cardiologist who can evaluate an ECG or perform a cardiology consultation.

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